That's oh-be-GUY-n, not oh-be-GIN, as some (primarily people from Texas) would like to refer to my chosen profession. Although, working in this field can sometimes cause one to develop a penchant for gin...hmmm.

Thursday, January 15, 2009

Commentary

There were a couple of comments from sarai on my last post that were rather lengthy, so rather than leave them in the comment section, I am posting them both here, in their entirety, along with my response. Italics are sarai's words, and the regular text words are mine

It can be very hard for the patient however, after having the doctor be wrong numerous times over the years with drastic consequences to your life. I don't watch Oprah, and the articles you mentioned irritate me, but yes, I do look for reputable internet sites, and before the internet was available, I researched.

sarai, I realize that your postings are coming from a place where you have been burned by the medical profession, but I certainly do not believe that physicians are anything more than fallible human beings who will make mistakes. That was not the point of the post.

That doesn't mean that I approach the doctor like I know more, and like I expect them to act as my puppet. But if I go to an OB appointment and say my baby isn't moving as much, and I am concerned about placental insufficiency, for example, I DONT want to hear "you're baby is moving just as much, it just doesn't feel the same because he has less room". Excuse me, doctor, YOU are not the one that's actually pregnant here, DON'T tell me how much my baby is or is not moving. YOU are not the one that will have to live with a dead child if there is a stillbirth (which the medical world is completely unable to understand how to prevent) I and MY HUSBAND ARE.

I think you are misunderstanding me. I *do* appreciate an informed patient. As I stated before, I practice collaborative medicine, not paternalistic care. I take my appointment time with patient to educate them and talk about treatment options. I even have a list of reputable internet sites on which to research information. That is completely different than someone coming in (or better yet, just calling the nurse line) and telling me that they have already diagnosed themselves, and now would like me to prescribe this medicine or order this test for them.

Again, I know that you've been hurt, but I am not the doctor that didn't listen well enough to you when you knew something was wrong, so please don't cyber yell at me. Just because I may vent my spleen on anonymous blog about things that irritate me about patients does not mean that I quickly dismiss them or am rude to them, quite the opposite actually. I take my patient's complaints seriously and act quickly on alarming symptoms. The dismissive attitude you are attributing to me does not apply in real life. You only see the seedy underbelly of my brain here.

You doctors don't always know how many times in person's life a previous doctor missed something important and the patient paid a heavy price. The doctor may have done nothing wrong, they may have met the standard of care, but to the person living with the consequences, it just doesn't matter, and they will do anything they can (watch Oprah, read really stupid Reader's Digest, surf the net) to try to make sure they get more observant care next time around.

Yes, as I said, "we doctors" are not omniscient. I did already know the patient about whom I posted, and have been doing her GYN care for 3 years now ( and each time I did her pap, her small speculum was warmed and lubed). She is not new to me or my practice. My care of her has been as observant as can be. Doctors are human, we do our best, and sometimes, despite our best efforts, it just isn't good enough. It sucks, and we try hard so it won't happen, and it bothers us perhaps more than you will ever know.

As a nurse, I've seen term babies stillborn, (decreased fetal movement, doctor ignored, or minimized), diarrhea was actually Ecoli, which turned into HUS, by the time treated (after being sent home 3 times) kid had stroke and ended up needing kidney transplant, a "viral upper resp infection" was actually a bacterial pneumonia, doc wouldnt believe patient couldn't breathe well 'cause sat was OK, vomiting and increasingly decreased LOC was actually juvenile onset diabetes (also sent home a few time before ER doc figured it out -- kid almost died.) This may be why some people are reading articles and trying to advocated more vigorously for their own care. I know I am. Even as I feel sincere empathy for you as I see the look on your face when you see my internet sheets........

See above, and there are even term stillborn babies where there were *no* warning signs. No decreased movement, no pain, no bleeding, sometimes babies just die. We do everything we can to prevent it, but despite our best efforts, babies still die. Yes, there are physicians that dismiss patient concerns, or miss pertinent signs, but we are not all the same person. Advocating for your own care (what you are talking about) and telling the doctor what to do and how to do it (what my post was about) are two different things entirely.

And here's something that just kind of bothers me about your blog, which, BTW, I otherwise enjoy reading.........it's judgement both from you and commenters, about women's birth choices.

Well, I can't speak for my commenters, but part of my job is to regard "women's birth choices" with my own clinical judgement. That's my job. If women come to me for care, they are, in fact, asking me to use my clinical judgement in their care.

If I'm reading your blog right (and correct me if I'm not), the "ideal" expectant mother in your practice wants to go into labor naturally, not mind being past due date, and not object if you feel at the last minute she needs a crash c-section. Moms who want to be induced (God forbid a week or two early) prefer a c-section straight off, or "insist" on a "happy vaginal midwife birth" even if things don't go according to plan are subjected to the eye roll.... Kind of a tall order, Dr. Whoo.....

I don't know if there is a "right" way to read my blog, so who am I to say who is "reading it right" or "reading it wrong?" I do think that you may perceive my words in a more malicious way than they are intended, and this is probably only highlighted by your bad experiences. I vent on this blog when things get tough to take, a safety valve, if you will, so that I do not blow up in the presence of an actual patient. There is no actual eye rolling going on in the presence of my patients. No matter their circumstances, personality quirks, or clinical needs, they are treated fairly and equally.

Loosely speaking, my "ideal" patient (as you put it) doesn't exist. My guidelines for delivery, elective or otherwise, are dictated both by the standard of obstetrical care, my clinical judgement, and the individual aspects of each patient. What I expect of my patient is a relationship of mutual respect and trust. Those are things that must be earned...by both parties. There is no "laying down the law." There is a give and take that is natural in these kinds of professional relationships, and quite honestly it doesn't merit many blogging entries because it is so routine. I don't think that you understand, you only see so much of me here.

One thing I did NOT NOT want with my first child was a crash c section. Either a vaginal birth, or a planned section, didn't care which. Of course, doc wouldn't do a c-section just because I wanted one, so we had a crash vag delivery with vacuum, (baby crashed too late to get c-section) where I got to experience watching my firstborn be revived, separated for her for hours after birth while she stabilized, and was so sore and torn up that I didn't want to have sex for months and months, and still deal with stress incontinence since that delivery well over a decade ago.....but because I didn't go to med school I didn't get to decide what would be better for me. I would like to argue, both as a nurse and as a mom which was physically better for me -- ugly vag birth or planned c-section. Yep, I'd choose c-section. Sorry.

I'm sorry that you had such a traumatic experience, and that it still haunts you. There is no way to predict when something like that is going to happen. Crash deliveries of any kind are heart stopping, but it *is* the physician's decision, in that moment, what will lead to the best outcome for mother *and* baby. If there is a terminal deceleration, and the baby is on the perineum, it is much more likely you will get a better fetal (and maternal) outcome with an assisted vaginal delivery.

I'm sorry that your bottom got torn up, and you had to undergo the trauma of seeing your daughter (successfully?) resuscitated. But, if I'm reading correctly, your baby survived. If your physician did what you wanted them to do, what you *perceived* to be "physically" better for you, and did a c-section, your baby's brain could have been deprived of several additional minutes of oxygen, with possible disastrous consequences. Whose fault would it be then? Yours? No, it wouldn't, it would be the physician's fault, who let the clouded judgement of an overly involved party (read, you) make the call. Instead of a torn up bottom, you could have hemorrhaged and required an emergent hysterectomy, precluding any future deliveries. Would you take the responsibility of zero future fertility, just because you *wanted* a surgery? Or is that the physician's responsibility? So yes, when you put your medical care into the hands of your physician...in that critical moment...you may not get to make that final call on what you *think* may be best for you. That is what a physician is there to do.

The recovery from next delivery was even worse, crash section, nobody's fault, but if I had it to do over again, possibility of crash section or planned section, well, I'd choose planned every single time. The crash carries psychological scars --- many of them. If you are lucky, you get to go to sleep and miss your baby being born. If you are unlucky, you have to stay awake, with no one talking to you, while your baby gets CPR. and your husband is God knows where. Physically, its a lot harder, too, and wound healing is not nearly as good than it is when the surgeon has time to take his time.

Agreed, but the point is the same, you cannot always predict these things. You said yourself, nobody's fault. Precisely. Planned surgeries are often more controlled than emergent surgeries...but not always. There are exceptions to every single "rule." Again, I sympathize that you have had such traumatic experiences, but the neither medical profession at large (in general) nor I (in particular) are to blame for this. I didn't have the perfect, ideal, rainbows and orgasms births that I would have loved to have, either, but I was fortunate and had 2 viable, healthy babies. I wouldn't trade that for any "experience."

The reason that patients want to run the show is because THEY have to live with the outcome!!!!!!! Tell yourself over and over and over again, its not about me, its not about me, its not about me!!!! especially in your profession where the stakes are so so high.......

But in order to be safe, objective, and effective the patients cannot feasibly run the show! They can (and should) be involved in the decision making process and development of a treatment plan, and they can consent or not consent, but they *cannot* "run the show." That is what a physician is supposed to do. Run the health care show.

This blog *is* about me! How I feel about the things that I do and that I see. Here, in this little corner of the internet, it *is* all about me. That doesn't mean that I disregard what my patients want. It also doesn't mean that I haven't had to make a decision that a patient was not capable of making on their own.

Maybe they really want to be induced when they know YOU, whom I'm sure they all really like, will be there. Maybe they are tired. Maybe afraid of late 3rd trimester stillbirth. Maybe they are struggling financially and need tax break. Maybe already not able to work anymore and trying to maximize maternity leave. Wanting to be induced at 38 1/2 weeks is not a sin.

Perhaps it isn't a "sin," per se, but it isn't valid medically. There is a lot of research to read about elective inductions, especially prior to 39 weeks. Often the outcomes are less than stellar, both maternal and fetal. Wanting your own physician, or "being tired," or "being afraid," or "needing a *tax* break (!)" are not viable indications for medical procedures that can have lasting impact on fetal and maternal health and well being. Elective induction of labor is associated with higher rates of cesarean deliveries, fetal distress (and dreaded "crash deliveries"), and fetal hospitalization for various immaturity issues.

Take a page from your midwives book. Listen to your patient. Ask questions. Try to figure out what the patient is afraid of. What she values. Try "why is this so important to you?" instead thinking "I can't believe she wants to have her baby by Christmas!" Find out what other experiences she has had with other health care providers. Maybe the last doc that did a pelvic jammed a large cold speculum where the sun does not shine, and she thinks you respect Oprah more than her. And remember, if she wanted a midwife, she'd probably be seeing one, so try to tactfully ask what she wants from your expertise, if you feel like she is treating you like her puppet.

Not to beat a dead horse, because I'm already feeling nuts for defending myself for talking about the way I feel on my own freaking blog, but how do you know that I *don't* listen? You don't know. You don't know me. You don't know how I treat my patients. The last doc that patient had for a pelvic exam was *me*, and I did not jam a cold, extra large speculum into her.

I've found that being a patient and having really horrible medical experiences makes me a lot less offended by my patients. Because if a patient asks me "will the doctor use a small, warmed speculum like it says to in Oprah's magizine?" my first thought is not to roll my eyes, it is to ask, "what has your past experiences with pelvic exams been like...."

Unfortunately, having really horrible medical experiences makes you a lot *more* offended by the things that I say, anonymously, on this blog, and causes you to extrapolate and frame my commentary in a less than favorable light. I hope my response has given you some insight. And truly, for all the snarking on the blog, I never forget that my patients are just people, just like me, with a different frame of reference. Even if it doesn't translate in text, I'm certain it translates well in person. I wish you healing as you attempt to move forward from your painful past experiences.

44 comments:

Love you! You do not need to defend yourself to her. I think she took your words, twisted them around and made the whole issue about her. Like you I am sorry that she had such a horrid experiance. No one but she and her doctors know why or what contributed to her issues. You are not to blame. Don't let some anonymous, bitter poster upset you. This is your blog, your ranting grounds, your place to talk about how you feel. Keep up the good work!

I appreciate your sharing this dialogue. I'm sorry you were the object of this poster's pent up anger and frustration; I thought you responded diplomatically and eloquently. Thanks again for a great blog.

As a medical student who is starting to realize exactly why physicians get burned out in this profession, my heart goes out to you. how quickly women forget that pregnancy used to often result in one or two deaths, before modern medicine and surgical intervention. People have been swept up into a cloud of mysticism to the point of thinking birth is not a risky event. How quickly we forget how many women died from hemorrhaging to death or infection before all of our so-called heartless medicine. I'm sorry that you are just trying to get things off of your chest, and this is how people respond to your blog.

hugs from a female med student, who would rather be cut and have a healthy, viable baby, then otherwise.

To the commenter: At 23 weeks I went into premature labor with my twins, 1 week prior, I had been to 2 doctors, neither caught my cervical change even though I was having contractions. I had 1 baby girl born 23 weeks and die 10 minutes later in my arms. The other baby girl was born at 23 weeks and 4 days and died 30 minutes later in my arms. I get not understanding how some doctors don't listen eventhoguh you have suffered so much.I am sorry you experienced all that you did, and it sucks, and coming from someone who watched her first 2 born daughters die in her arms at the hospital, I know how you can feel somewhat "I need to be in charge"... but there is difference in being incharge of your own care and putting the doctors license at risk... if she does what you tell her and she is wrong and something happens, it is still her fault. If you can't trust your doctor again, don't go to one.And why attack people over the internet? sheesh.. just quit reading if you don't agree.

I started reading your blog while I was pregnant with my third child. I love it and really enjoy getting a physician's perspective. Please keep it up.

I can even add that I was a patient who begged to be induced early this time because I was on bedrest and my second daughter weighed 10 pounds, 5 ounces (no gestational diabetes) and had to be delivered with a vacuum (she is fine although later developed craniosynostosis that needed surgical correction). I desperately wanted to deliver early to avoid another such delivery. I was lucky though because I have a physician, who like you, understands the science and was great in explaining why inductions really should wait until 39 weeks and aren't always the best option. I did get my wish to be induced at 39 weeks, but it was medically necessary and everything turned out fine. Thanks again for sharing your perspective! We need to keep good physicians like you so I'm going to say something you probably don't hear enough: THANK YOU for all of your sacrifices!

Please don't quit writing your true feelings because some commenter took you the wrong way. Your blog is one of my favorites, and I love the way you lay it all out there. Just like any other blog, I read yours as your opinion.

You are not the one that needs to question your motives. Sarai is. And while I sympathize with her over her traumatic experiences, she needs to know that not every crash C-Section (which I believe saved my son's life) and every crash delivery (which I believe saved my Godson's life) is a traumatic experience, but sometimes a blessing.

I have come to appreciate that doctors are people - well, that came from having them as church members and playing in the symphony with them and when one of my doctors got a horrible perm to cover up his thinning hair... ANYWAY! I try to get others around me to think about doctors simply this way, they are experts and they are fallible, they do what they can but they have a limited time to figure out what is going on with you at any appointment so you need to help them by being straightforward with what's going on and not expect them to ask all the right questions. I think expecting my doctors to be perfect and always get it right is too much and not fair, but expecting them to be right most of the time is a fair expectation.

As for the speculum I'd wish they'd start with the biggest first since I prefer as few insertions as possible, but they never believe me when I say get out the big guns (I'm tall, that cervix is far from the end...). Guess I should be glad my uterus is staying so high up in my pelvis.

Anyway, chin up! Most of us appreciate your blog and the insights that we'd otherwise never get, at least I do. I'd like to think it makes me a better patient too.

i'm constantly amazed by the people who comment about "not liking your blog" or "being in disagreement on most issues" or whatever... i usually just yell at the computer-- "WELL, WHY DO YOU CONTINUE READING IT THEN? DUH." Seriously, if people get so upset by reading it, they should just stay away, or get a grip and have a reality check, sheesh.

I think your blog was great! I even did a blog about it and put a link to that blog you wrote! sorry you had to defend yourself so much, she obviously has things to deal with. I hope she is never my nurse :|

I completely agree with coffeeandtea above that there is somewhat of a delusion in society as a whole that birth is not as risky as it really is. I would include myself in that category until I had my third child. Although my complications were minor compared to some of the commenters (my heart truly goes out to you), it was enough for me to get a reality check. Birth is risky and sometimes things happen that are no one's fault and could not have been prevented. Don't feel like you need to defend yourself. If people can't tell you are a wonderful doctor from reading your blog, then no amount of defending / explaining will change their mind. With that, I will go crack open a bottle of wine for you :) Amy in OH

I've been reading your blog for quite awhile now and I enjoy it very much. I had a horrible and very traumatic preterm delivery with my first child. I had the unfortunate experience of being delivered by a first year resident who was completely unprepared for the hemorrhage that followed. My OB couldn't make it in time, I went from 4cm to 10cm in 6 minutes and the baby almost shot out on her own! I came very close to dying.

I chose my OB for my second child with more care. I am sure that if she has a blog in which she vents about pain in the butt patients- I feature prominently in it for at least 7 months out of that year LOL! But she was never anything but courteous, attentive and professional with me. She listened to my obsessive compulsive fears and never once called me a loon. Because she listened, she caught my preterm labor immediately when it started at 28 weeks. She aggressively managed my care and my son was born at 37 weeks on the nose. I did have a scary delivery cause once again I went from 4cm to 10 in minutes and baby's heartrate went down and stayed down. Never have I been so grateful for my OB- she was calm, steady and encouraging even while I was panicked. Because of her, my son is perfectly healthy.

I'd take you as my OB any day, just from reading your blog. Thanks for sharing.

Doctors are human, and I think we all forget that. My family has been repetitively subjected to doctors who cannot figure out what is wrong with them. It is overly frustrating to me, a premed undergrad, because when they don't get better, they call me-- a girl with 7/8 of a bachelors degree to save the day. Sometimes things are not easy to diagnose, and even more difficult to treat-- it is the way of the land. But we have to keep in mind that our doctors have our best interests at heart.

What I love is that the commenter is saying that basically you should give patients whatever they want - that early elective induction, that scheduled primary c-section without any indication - but yet you should be more like a *midwife.* Correct me if I'm wrong, but aren't the midwives the ones yelling at us OBs for doing all these elective, non-indicated procedures?!?

Also, if she wants to run the show she can either (a) go to med school or (b) figure it all out herself, without us. Wouldn't that be dreamy.

Dr. Whoo, continue to use this blog as your outlet for the things you feel you need to rant about. People forget that pregnancy/childbirth can be potentially hazardous. People died (and still die all the time in developing nations) from something as natural as giving birth. All those interventions sarai named(the induction, the elective cesareans) can lead to complications, something she would have known had she and her physician had a discussion about them. This is the only speciality where everyone wants a perfect outcome. When it doesn't happen, it's the doctor's fault. I say hell no to that. I, as an OB, am sick and tired of the misinformed, the skewed info from people like Ricki Lake and even Lady O, dictating how I am to practice my field. Do not let this obviously uninformed witch (but i wanted to say the other word) sway you from the right to blog the way you want. She doesn't like what you have to say , she doesn't have to read. Congrats again on board certification =)

wow. and may I say again, WOW. I hadn't read the comments on the last post, and his blows my mind.

I am from what would appear to be the opposite camp, in that I am a naturopathic physician and midwife, so I do home births. I am often the person people come to when they have had unpleasant experiences previously, or worse when they have read and watched scary things that tell them they *will* have one if they aren't careful.

I agree with everything Dr. Whoo says in both of these posts, and in general. Everything. EVERYTHING. I am the supposedly touchy-feely "hippie vaginal birth" midwife, and I can't and wouldn't pick a single point.

One of my biggest problems these days is that women think that being educated and choosing, say, a home birth, means that they will get one. It doesn't work that way. Sometimes we have to go to the hospital. Some babies need to come by c-section. Some even need to come by crash c-section, which is certainly no one's first choice.

However, to say "I want to schedule a c-section so I can avoid a crash c-section" is insane. Really. No responsible physician will say yes to that, especially for a first time mom. It pretty much guarantees her repeat c-sections, and every doc I know around here will work his or her butt off to protect the vaginal birth, especially for the primip.

Doctors do make decisions. Just because you have researched and read about the choices doesn't mean you get to choose what your birth will be. It doesn't work that way. This is not buying a damned car, people, it is an entirely unpredictable event and you can hope for the best and have lots of dreams, but I have news for you, from the hippie midwife: giving birth is NOT about the mother. It is about the baby, and what the baby needs. The mother's desire for a vaginal birth does NOT trump the baby's need to get out right now, or suffer brain damage. It just doesn't.

So now I sound like a cold, unfeeling, um, female dog. But you know what? I'm not. I think that my biggest job is to make women OK with birth, no matter what happens. My best successes are the women who transport to the hospital and have c-sections and don't feel traumatized by them. Who feel that they were heard and that they tried and that they made the best decisions they could for THEIR BABIES. Who really understand at the end of it all that the most important decision they made as a mother was when they ignored everything they wanted and dreamed about in the face of evidence that their baby needed something different.

So there we are. Feel free to tell me what a terrible midwife I must be.

Wow Dr. Whoo. I'm sorry that you had to respond to that. I cannot begin to imagine going into a doctor's office (ob or any) and demanding to be treated as I desired. I think my favorite part of this comment from Sarai was the part about down on their luck people needing a planned delivery for a tax break. Right. That's a great reason to have a child.

I hate how people assume that they can always do someone's job better than they can. It seems that no matter what field we go into, they way society has shaped people into having an inflated sense of self worth makes them think they are the know all and end all. It seems no profession is exempt from this!

I think it is ironic that someone would post on your blog that you should take a page out of the midwives' book, and then tells you to do early inductions because the pregnant mom is tired. I can't believe she tells you to know that they will live with the consequences of your actions for the rest of their lives, and then tells you to do unindicated care with statistically worse outcomes (elective cesarean, early inductions).

And, I can't believe she would tell you that you don't listen to your patients. Sorry about that. It's hard to put it out there and be subject to people's reactions.

I have all the sympathy in the world. I think informed consent is sacred, but as long as both parties know (practitioner and patient) what the risks are of a procedure, the practitioner gets to decide what to do, and the patient gets to decide whether to accept that decision or to shop for another practitioner.

Obviously this isn't possible in all situations, if there is an emergent condition or the patient doesn't have the financial or social means to shop around. But, otherwise, that's how it should work.

Many times I feel sorry for my docs. You are damned if you do and damned if you don't and if the results are less than perfect then you are always at fault. Keep doing what you do and remember that most people are reasonable and not as judgemental.

thank you thank you thank you. I am a small town doc who struggles daily with so many of these issues you so eloquently post about on your blog. I was feeling so alone and just plain sad until I found your blog and the mothers in medicine blog. Thank you because I now do not feel that I am alone!

This post is just why I find it so hard to do medicine some days and wish I was doing something else - anything else! But, it's the responses above and people who do appreciate my expertise and respect me that bring me back to why I'm here - out in the prairie, doing my best, and trying to be patient when my patient asked about their hemorrhoids in the grocery story last night, and trying not to take it personal when a patient I have worked so hard for asks to switch to my partner.

so, keep venting, and sharing why this is one of the toughest jobs out there - thanks again!!

Wow....well not to restate the obvious but...(1)It's your blog and you can really write whatever you want, no one is forced to read/agree with it...in fact rather than leaving rambling messages they can not read it

(2)people seem to forget that pregnancy is more than cute maternity wear and weight gain the list of things that can go wrong in the peri and postpartum period are huge

(3)childbirth is very natural and naturally remains a major cause of death for women and infant in the developing world.

(4)as for calling the shots, I'm an M.D. and when I delivered while a discussed options with my OB I inherently trusted her to make objective decisions that I knew I couldn't do

(5)It's easy to play monday morning quaterback but much harder to call the shots as its happening

(6) this won't be popular BUT..I've heard nurses complaining in hospital about they're plan for patients not being followed and guess what....ITS MY ASS ON THE LINE...it's easy to complain and wax poetic when the responsiblity for outcome doesn't ultimately falll on you, so spare me.

I just wanted to chime in and agree with all the previous supporters. What the hell is the point of going to a physician if you're just going to make demands, regardless of medical indication. I do like the idea of my doctor keeping me informed and seeking my opinion/preference when possible. That said, the initials after my name aren't MD or Do, so I will defer to them...

Finally, it's your blog, and you can say what you want!! Based on the way you write (i.e., your philosophies regarding the practice of medicine), I'd let you do my pelvic any day of the week. ;) Keep up the great work, Dr. Whoo!

Dr Whoo..I've been lurking a lot more than commenting, but WOW. This post was amazing. I can't understand where this woman is coming from (actually, as a CNM I have run across it, but still don't understand it).

@Lizard: You are very correct. It's about the baby. A safe delivery for both, and a healthy baby. I went to a great lecture by Ina May Gaskin several years ago. She said many of the things you did.

Oh my god, Dr. Whoo. I cannot believe this woman wrote all of this stuff - and I'm SO FREAKIN' PROUD of you for responding in this way.

ALSO - holy crap, that mention of the tax break reminded me - my co-worker knows a woman who insisted on a c-section super-early (or tried to insist; I can't remember whether she got away with it or not) because she "HAD to have this baby in 2008 for tax purposes". SERIOUSLY??? Who ARE these people?

Wow - this is the first time I've read your blog. I have quite a few questions for Sarai - If you read a cookbook, can you compete with Bobby Flay? When you got your driver's license, did you tell Richard Petty that he should ease up in the corners?

I have nothing nice to say, except I've instantly become a Dr. Whooo fan.

wow, ob-gyn, this is why I dont vent my really seep personal thoughts on my blog, when I started to it attracted email from people who had all sorts of projections and expectations of me. On top of it, I am a psychiatry resident and have my name on my blog, and it just took a few annoying comments to make the whole thing unpleasant! it bordered on harassment! so i just stopped the semi personal soft (no less!) commentary which I have butt-loads of to begin with.

Bless you for even going as far as you did in your response, you know you didn't have to... because these complaints had NOTHING to do with you. And there was nothing you could have said to make it better for her. I am sorry she is in pain.

I appreciated the dialogue here. Thanks for your comments, Dr. Whoo. To Sarai and other patients: Like many, I became a physician to help people. It's a hard job to do. We are trying to make our decisions on the best evidence available. That's because, believe it or not, we actually want what's best for you, our patient. We are trying very hard not to miss anything that could cause you bad long-term consequences. We don't want any harm to come to you or your baby. At the end of the day, if we schedule you an early induction, and then your baby has transient tachypnea and spends 3 weeks in the NICU, we are grieved, too. Or we hesitant to do an emergency C-Section because you don't want one when our experience and knowledge tell us that your baby is in danger and your baby dies or has long term damage, we don't ever forget about it. Yes, you as the patient, have to live with it. But we have to live with how our decisions affect you, too, and we've worked too hard, spent too much time away from our family, and gotten too much grief in our altruistic persuits to also loose sleep when you run the show and have a bad outcome. Not to mention the million dollar lawsuit that we might end up with. We are doing the best we can for you. We do a good job most of the time. Bad things happen enough even with our best showing. Sure, continue to keep us on our toes. But don't be too hard on us either. -OB resident

Dr Whoo, I loved what you, Lizard and coffee and tea said. Couldn't agree more. And my being here (and my mother still being here) is a testament to all that has been said - a crash Caesar was needed to deliver me (2.3kg and with lots of scary decels), saving my life, and half an hour later my mothers life was saved by the anesthetist when she VFibbed on the table. We have a great relationship despite often being separated geographically (despite many people telling me that Csections can interfere with bonding), and even though she didn't see me for 8 hours after I was born because we were both in ICU. And she went on to deliver my sister the natural way. So hooray for the anaesthetists, midwives and obgyns who were involved.

Honestly, you sound like my ideal OB. Willing to wait and be patient but ready to jump in if there's a problem. Willing to listen to my preferences, but never at the expense of my safety or my baby's. You don't happen to practice in the Kansas City area, do you?